High Frequency Jet Ventilation is most commonly administered via transcricothyroid puncture, or transtracheal puncture, with placement of a narrow catheter. A number of transcricothyroid or transtracheal puncture/catheter placement devices are known in the art. For example, U.S. Pat. No. 4,488,545 to Shen discloses a catheter placement device for use in introducing high frequency jet ventilation gas to the trachea of a patient. The catheter introducer of the catheter placement device contains a spring-actuated retractable needle, and the catheter introducer is designed to be removed from the catheter prior to HFJV connection. U.S. Pat. No. 4,593,687 to Gray et al. discloses a tracheal catheter tube having a removable magnetic stylet, which stylet upon removal from the inserted catheter permits expansion of the bulbed end to lock the tube inside the tracheal wall. U.S. Pat. No. 4,364,391 discloses a tracheostomy apparatus which includes structural elements used in sequence. Two coaxial needles are inserted into the tracheal lumen. After removal of the inner needle, a catheter is placed by inserting the leader of a dilator contained within the catheter through the outer needle, removing the outer needle, pushing the catheter into place and removing the dilator. U.S. Pat. No. 3,788,326 to Jacobs discloses a distally perforated ventilation catheter which can be introduced either through the mouth or percutaneously. U.S. Pat. No. 4,556,059 to Adamson, Jr., discloses a spring-operated tracheotome.
Theoretically, percutaneous catheters for tracheal insertion should be easy to position and should lead to minimal bleeding and/or complications due to their relatively narrow diameter. In practice, however, particularly in the emergency setting, placement of prior art, relatively large diameter percutaneous tracheostomy catheters is difficult, must be performed slowly, and has resulted in unacceptable blood loss and trauma. Even under conditions of cervical vertebrae immobilization, as is customary in emergency care generally, blood loss and trauma (and resultant complications) occur as a result of inevitable anatomic movements in the densely vascularized neck area. Accordingly, during swallowing, breathing (if spontaneous breathing is present) and musculature movement, bleeding is exacerbated, catheter anchors tend to dislodge and the catheters themselves tend to knot or kink. In the event of any of these undesired occurrences, adjustment or reinsertion of the catheter becomes necessary, and the adjustment or reinsertion itself inevitably produces more trauma (including loss of ventilatory support and airway control) and/or bleeding.
In view of the above, a need persists for a transcricothyroid catheter which minimizes or eliminates knotting or kinking, bleeding, neck trauma and resultant complications. Such a device would optimally self-adjust to accommodate normal anatomic movement of the neck without dislodging or compressing surrounding tissues, to enable the catheter to remain in place for extended periods.